

<!--WSTAG name="prog_suivant" -->

<script type="text/javascript">
		jQuery(document).ready(function(){
			// binds form submission and fields to the validation engine
			jQuery("#form").validationEngine({autoHidePrompt:true, autoHidePromptDelay:500});
		});
</script>

<!--WSTAG name="texte1" -->
<form id="form" class="formular" method="post" name="forec">
  <!--WSTAG name="texte2" -->
<fieldset>

    <label class="full">
		<span class="mandatory">*</span>
        <input name="civilfx" type="radio" id="civilf1" value="Mo"><label class="civil" for="civilf1"><!--WSTAG name="lab-mo" --></label>
        <input name="civilfx" type="radio" id="civilf2" value="Ma"><label class="civil" for="civilf1"><!--WSTAG name="lab-ma" --></label>
        <input name="civilfx" type="radio" id="civilf3" value="Me"><label class="civil" for="civilf1"><!--WSTAG name="lab-me" --></label>
	</label>
	<label>
		<span class="mandatory">*</span> <!--WSTAG name="lab_nom" -->
		<input type="text" id="nomf3" name="nomfx" class="validate[required] text-input">
	</label>
	<label>
		<span class="mandatory">*</span> <!--WSTAG name="lab_prenom" -->
		<input type="text" id="nomf33" name="nomfxx" class="validate[required] text-input">
	</label>
    <div style="display: inline-block;">
	<label>
		<span class="mandatory">*</span> <!--WSTAG name="lab_adresse" -->
		<input type="text" id="adr1f" name="adr1f" class="validate[required] text-input">
		<input name="adr2f" type="text" id="adr2f" class="text-input">
		<input name="adr3f" type="text" id="adr3f" class="text-input">
	</label>
	<div style="width:260px;float:left;">
		<label>
			<span style="width:100%;float:left"><span class="mandatory">*</span><!--WSTAG name="lab_local" --></span>
			<input name="nopostf" type="text" id="nopostf" maxlength="10" class="validate[required,custom[integer]] text-input">
			<input name="localf" type="text" id="localf" maxlength="50" class="validate[required] text-input">
		</label>
	</div>
	<label>
		<span class="mandatory">*</span> <!--WSTAG name="lab_pays" -->
		<select size="1" id="paysf"  name="paysf" class="validate[required]">
        </select>
	</label>
	</div>
	<label>
		<span class="mandatory">*</span> <!--WSTAG name="lab_mail" -->
		<input type="text" id="mailf" name="mailf" class="validate[required,custom[email]] text-input">
	</label>
	<label>
		<!--WSTAG name="lab_tel" -->
		<input type="text" id="telf" name="telf" class="text-input">
	</label>
	<label class="full" style="display:none;">
		<input type="checkbox" name="news" id="news" class="checkbox">
		<span class="checkbox"><!--WSTAG name="lab_news" --></span>
	</label>
	<label class="full">
  <!--WSTAG name="navigation" -->
	</label> 
  
  <input type="hidden" name="FRowid" value="?">
  <input type="hidden" name="LRowid" value="?">
  <input type="hidden" name="lang" value="10">
  <input type="hidden" name="par-prog" value="?">
  <div style="display:none;">
<!--WSTAG name="err_adr" -->
<!--WSTAG name="lab_mobli" -->
<!--WSTAG name="lab_natel" -->
<input type="hidden" name="natelf" >
<!--WSTAG name="err_pwd" -->
</div>
<!--WSTAG name="texte3" -->
</fieldset>
</form>

<!--WSTAG name="erreur" -->
